Four particular psychedelics have been the subject of most of the recent psychiatric research and have been or are being investigated in terms of eating disorders—Ketamine, MDMA, Psilocybin, and Ayahuasca.

Ketamine has been used in higher dosages as an anesthetic for decades. In lower dosages, it can temporarily modify consciousness. It has been studied for the treatment of depression, obsessive-compulsive disorder, and post-traumatic stress disorder. Over several decades, research has shown that ketamine has antidepressive properties.

Because it is already an approved medication, it has been incorporated more readily into the treatment of psychiatric disorders via off-label use. Ketamine infusion therapy involves the administration of a single infusion or a series of infusions for the management of psychiatric disorders.

Esketamine nasal spray, a derivative of ketamine, has been separately approved by the FDA for treatment-resistant depression.Trials of ketamine-assisted psychotherapy are also underway and may increase the effectiveness of the treatment. Ketamine may not have been investigated specifically for eating disorders yet, but patients with depression may already be accessing it.

MDMA is MethylenodioxyMetamphetamine is commonly confused with the street drug “ecstasy” (also known as “molly”). However, these illegal products are often substitutes that contain no actual MDMA, and may contain only substitutes.

MDMA has been designated a breakthrough therapy for PTSD by FDA, a status that can lead to expedited approval. Therapeutic results with severe treatment-resistant PTSD patients were significant with approximately 70% of participants no longer qualifying for the diagnosis 12 months following treatment.

Currently underway is an open-label, multi-site Phase 2 study of the safety and feasibility of MDMA-assisted psychotherapy for eating disorders. This is a multi-site study of individuals with anorexia nervosa restricting subtype and binge-eating disorder. The study is taking place at three sites including Vancouver, Canada, Toronto, Canada, and Denver, Colorado.

Psilocybin is the active ingredient in what are commonly known as “magic mushrooms”. Psilocybin has been studied in patients with depression, anxiety, obsessive compulsive disorder, and addiction. Psilocybin received a breakthrough designation from the FDA for individuals with treatment-refractory depression. In 2020 Oregon became the first state in the country to legalize psilocybin for medical use.

A current study is underway to explore the safety, tolerability, and efficacy of psilocybin for individuals with anorexia nervosa.

Participants will receive a single 25 mg dose of psilocybin along with psychotherapeutic support, which includes preparation and integration sessions surrounding the experience. This trial is being conducted in Baltimore, Maryland and San Diego, California.

Researcher and psilocybin therapist Stephanie Knatz Peck, Ph.D. who was involved in a psilocybin-assisted trial for the treatment of depression and now is working on the anorexia study said this:

"Psilocybin-assisted therapy holds tremendous promise for mental health. Studies evaluating the therapy for depression, end-of-life anxiety, and smoking cessation have produced impressively robust improvements in symptoms and more studies are underway evaluating the treatment for other mental illnesses.

We are excited to evaluate the usefulness of this therapy for anorexia nervosa, particularly given the lack of good treatment options currently available. Our UCSD study is a small pilot study evaluating the safety, tolerability, and initial efficacy of psilocybin-assisted therapy for adults with anorexia nervosa." 

Ayahuasca is a traditional Amazonian psychoactive plant-based tea used in rituals by indigenous leaders and as part of religious ceremonies. Its use has spread to other parts of the world. People who drink ayahuasca usually report powerful visions and mystical experiences. It is usually drunk in traditional-style shamanic, religious ceremonies.

Participants typically drink a small glass of the tea in a ceremony that can last between four to eight hours. They may experience nausea, vomiting, sweating, and altered states of consciousness. Research on ayahuasca shows it might be helpful for mental health problems including depression, anxiety, and addictions.

People with eating disorder histories have been participating in ayahuasca ceremonies. One retrospective study of participants by La France and colleagues concluded that “ceremonial ayahuasca drinking may have promise as an alternative treatment.” The majority of participants surveyed reported significant insights about their illness and believed that ayahuasca has led to reductions in eating disorder symptoms. They also reported that the experience nurtured their self-compassion.